Monthly Archives: August 2016

Pill mills are a problem in Wisconsin. Here is just one example – on June 24th of this year the Milwaukee Journal Sentinel online reported that a doctor, Steven Kotsonis and office manager, Susan Moyer from a Wauwatosa medical office, were arrested on charges including conspiracy and illegally providing drugs to patients. The indictment stems from an investigation into whether they illegally provided drugs to patients from the Compassionate Care Clinic on W. Capitol Drive in Wauwatosa in 2012 and 2013. Moyer, who described herself as the “Oxyczar” and Kotsonis face 20 years in prison if convicted on all of the counts they face. Federal sentencing guidelines make that very doubtful, they will likely serve a fraction of that, IF they are even convicted.

Moyer accepted cash for prescriptions for large amounts of prescription narcotics. Kotsonis signed the prescriptions, often times without even seeing the patient. This is an example of a pill mill, in our own backyard.

What is a pill mill exactly? Basically, a pill mill is a business in which a doctor, clinic and/or pharmacy prescribes and/or dispenses narcotics without a legitimate medical purpose. They can be difficult to detect, but some warning sign are…

No physical exams are performed

Pain is only treated with pills

Patients congregating in the parking lot

Patients are in and out of the doctor’s office in minutes

Excessive traffic to and from the doctor’s office

Complaints from pharmacists about doctor’s practices

Complaints from neighboring business owners about clientele

Cash is the only payment accepted

Large cash deposits at the bank

The local and federal governments are responsible for finding these types of criminals, because that’s what they are-greedy criminals, and taking care to stop them. But, it takes a long time to complete these investigations. For Kotsonis and Moyer, the offences resulting in the charges they now face and were arrested for 2 months ago, were committed in 2012 and 2013. The clinic under fire was closed, but nothing has happened to “Dr.” Kotsonis’s license. There is no record of any investigation or disciplinary action on his license by the state of Wisconsin. In fact, he is practicing again through the Stevanovic Family Clinic in Milwaukee, introduced simply as “Dr. Steven”. How is it possible that he can continue unabated after what he was responsible for? At a minimum, we should be able to see that he was investigated, that he has to account for what he is now doing, that he can’t write prescriptions, or at least that they are monitored. But there is none of that, why?

When I was arrested and charged I was fired, and legitimately so. My license was suspended and to get it back I had to do many things to prove I had changed my behavior. This seemed reasonable to me, I had stolen and used drugs and I needed to show that I wasn’t going to do that anymore. My punishment fit my crime. But for these two goofballs, there seems to be no consequence over the last few years. If there has been, it is not documented anywhere that I can find. This does not seem right, we need to change the way we address these types of crimes, these pill mills.

The doctor in this Healthline article, Dr. Tseng, ran a pill mill that resulted in the death of college student who was just a few months shy of graduating. He and his friends got prescriptions for Oxy and Xanax from Tseng and mixed them with alcohol. Tseng was charged in his death, the charge was second-degree murder, she was convicted and sentenced to 30 years to life in prison. She’s the first doctor in this country to be charged and convicted in a case stemming from running a pill mill. Even though she had been notified that one of her patients had died of an overdose from the drugs she prescribed, she did not change her prescribing habits…no remorse. No remorse that is until she found herself facing 30 years to life in prison. I hope that other people running pill mills hear of her story and change their ways. Places such as these are escalating the opioid addiction problem, making it far too easy to get these dangerous drugs. They must be stopped.

In light of the ever increasing problem of addiction, the federal government is looking more closely at questionable practices. The above article gives many examples of clinics, doctors and pharmacists that have been caught and indicted. What happens then is up to the courts, and I hope the licensing boards remove the rights of these people to prescribe narcotics permanently. Unless there are severe consequences the greed will overpower the fear of being caught and the pill mills will continue.

If you see evidence of a pill mill in your area, tell someone. Since they are federally regulated, I suggest starting there. We have to work together to make a difference. We have to work together to make our neighborhoods safe from these places and their clientele. We cannot let them continue, we just can’t.

Today I would like to share a bit about the Florida Board of Nursing’s “Intervention Project for Nurses” or IPN. It is similar to other Diversion Programs that many states have, including Wisconsin, but it has a piece to it that is a bit different…they have a statewide support groups for nurses. This interested me, what a great idea. To have nurses that have been through the same issues talk to those who are beginning their journey is a very valuable tool.

“The mission of IPN is to ensure public health and safety by providing an avenue for swift intervention/close monitoring and advocacy of nurses whose practice may be impaired due to the use, misuse, or abuse of alcohol or drugs, or a mental and/or physical condition. IPN is authorized by Florida Statute, Chapter 464/456, to assist those nurses whose practice is affected.”

“Program Objectives…

To ensure public health and safety through a program that provides close monitoring of nurses who are unsafe to practice, due to the use of drugs including alcohol and/or psychiatric, psychological or a physical condition (chapter 455.261).

To provide a program for affected nurses to be rehabilitated in a therapeutic, non-punitive, and confidential process.

To provide an opportunity for retention of nurses within the nursing profession

To facilitate early intervention, thereby decreasing the time between the nurse’s acknowledgment of the problem and his/her entry into a recovery program.

To require the nurse to withdraw from practice immediately, and until such time that the IPN is assured that he/she is able to safely return to the practice of nursing.

To provide a cost effective alternative to the traditional disciplinary process.

To develop a statewide resource network for referring nurses to appropriate services.

To provide confidential consultations for Nurse Managers.”

Most of these objectives correlate with what we have here in Wisconsin. But like I said, the support network is different. The IPN has a vast network of resources for nurses. Florida has 150 Nurse Support Groups throughout the state. Each group has a facilitator. This is what one had to say, “I have been a Nurse Support Group Facilitator for over 12 years. I have witnessed many nurses come and go from my groups. The “magic” of the Nurse Support Group lies in the fact that a nurse who feels totally alone and full of negative self-talk and shame, secondary to his or her substance use disorder, attends group with other colleagues who have struggled with similar feelings and circumstances. There is a realization that “I am not alone anymore” and hope is born.” And one of the participants shared this, “Walking into my Nurse Support Group the first time surprised me. I will never forget the experience. My first surprise was how welcoming folks were to me. I listened as members shared a little about themselves with me, and I was amazed how similar the stories were to mine! I left that night with a sense of hope.”

I am going to write to the Wisconsin Board of Nursing (BON) to suggest we start a program like this one and I am going to offer to help get it going. I’m not sure how far I will get, but it is worth a try. I know when I first started this journey, I needed to speak to other people going through what I was. I was lucky in the sense that my counselor had another nurse she was treating with almost the exact same issues. What I didn’t have was someone who had been successful in going through the BON’s program and returning to practice. It would have been very helpful to have someone walk me through the process. As it was, I fumbled around with a lot of anxiety and some missteps. I would love to be a resource for nurses new to the BON monitoring program and new to sobriety. 12 step programs are essential in my opinion and they have worked so well for me, but they do not include anything about how to recover as a nurse. Including how to navigate the overwhelming program requirements, how to deal with the feelings of shame and remorse, how to get to a point where working as a nurse is a possibility again. I could be that resource, there are many like me that could. Let’s get together to make a difference in this lovely state of Wisconsin. If you are a nurse in recovery and would like to join me in my quest, please use the ‘Contact Us’ form and send me an email with your contact information. Together we can make a difference.